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Caring for Patients Without Providing Patient Care: The Role of the Pilot Outside of the Cockpit

Eugene Reynolds, BA * Life Flight Network, Aurora, OR

In many fire departments, firefighters are also trained as emergency medical technicians or paramedics. This has obvious benefits because most of the calls for service to which fire units are dispatched involve a medical emergency. However, in some fire departments, especially volunteer departments, firefighters may have little to no medical training at all, meaning they can provide little to no patient care. This can create complications when these individuals are dispatched to medical calls. This is the case with the fire department in my hometown. Before obtaining my National Registry Emergency Medical Technicians certification, I served as a volunteer firefighter without any real medical training. I was what many referred to as a “firefighter only.” When we who were “firefighters only” would respond to medical calls, there was not much for us to do or so it seemed. The emergency medical technicians and paramedics on the call would roll their eyes and wonder why we were even there to begin with. I found this frustrating and felt compelled to do something about it. Having read several books on leadership and customer service including Chief Alan Brunacini's Essentials of Fire Department Customer Service, I wrote a short piece titled “Caring for Patients Without Providing Patient Care” to be included in our department's firefighter training handbook. It turned out to be quite helpful on more than 1 occasion.

Now I serve as an assistant chief pilot for an air medical transport company in the Pacific Northwest. Part of my responsibilities include interviewing helicopter pilot applicants. One of the questions I usually ask a candidate is “What does customer service mean to you as an air ambulance pilot? What do you think your role is outside of the cockpit?” I have received many different answers over the years—some good and some not so good. I realized that this concept is misunderstood or foreign to many people who work very technical and specialized jobs. When the pilot steps out of the cockpit, their role changes a bit or I should say expands. They are no longer “just a pilot.” Instead of being a highly skilled aviation technical expert whose stick wiggling and automation management skills are second to none, they become, among other things, a customer service agent and ambassador for the company—one who is a critical component to the overall success or failure of the operation.

During the interview process, we also present a few different scenarios to the candidate and ask them how they would respond when faced with customer service issues not related to flying the aircraft. Again, the responses vary widely—some entertaining, some logical, and some quite absurd. One of the scenarios we like to pose is as follows: “It is early evening on a Thursday just prior to a busy holiday weekend. You've landed your helicopter on an interstate to pick up a patient involved in a motor vehicle accident. The highway patrol has the roadway closed, and traffic is backed up for many miles. You are asked to shut down due to the prolonged extrication of the patient. With extrication and patient packaging complete, the emergency workers and your med crew begin to load the patient into the aircraft. While this is happening, you are diligently checking the weather for the destination trauma center. During start-up, you realize that the navigation and hazard database for the GPS just expired and the new database was not loaded. What do you do?”

There are many potential courses of action here, and one may not initially see this as a customer service scenario; however, this is the perfect opportunity for a follow-up discussion. It is always interesting to see where the conversation leads regarding regulations, different company polices, discrepancy deferment processes, pilot judgment, and an understanding of the rules. After some discussion, especially if they have chosen to depart the scene, I tell the candidate, “You now experience a second malfunction that prevents the helicopter from immediately departing. The incident commander on the ground is irate, wondering why you are now shutting down again and ordering you to move the helicopter so they can open the highway and get traffic moving again. Now, what do you do?”

Once the candidate determines that the aircraft cannot be immediately moved without following some company maintenance process, we then ask, “How does your role as the pilot change in this situation? How do you handle the visibly upset incident commander? What do you say or do at this point now that you are no longer piloting the aircraft?” Again, the answers have varied widely but are always interesting, including pilots saying they would fly the helicopter anyway, disregarding best practice. We could debate the options all day long, but the point of the question is to see how the pilot thinks and behaves outside of the cockpit when their technical aviation skills are no longer relevant and what solutions they bring to the team when faced with problems other than those related to flying, especially situations that are potentially volatile and uncomfortable.

The majority of air ambulance pilots do not have experience in medicine or emergency services. Some may, giving them valuable insight into the nature of the industry and the challenging work performed by clinicians every day, but this is not the norm. In most cases, this is a good thing because we do not want our pilots being biased in any way in their decision making when it comes to the condition of the patient or the nature of the transport. However, regardless of experience, we are never “just pilots.”

On every patient transport, our pilots find themselves responding to a medical call without having any official medical training. What can a pilot do when they are no longer piloting? Legally, a pilot cannot do much in regard to medical care for the patient unless it falls within their training and medical certification of cardiopulmonary resuscitation, bleeding control, and so on. They are primarily there to assist with manpower as needed; lifting, loading, and getting equipment from the apparatus are a few examples. However, there is plenty they can do outside of their traditional flying duties!

In Chief Alan Brunacini's Essentials of Fire Department Customer Service, he states the following: “Our essential mission and number one priority is to deliver the best possible service to our customers.”1(p9) These people, on their darkest day, who need your help are not just “customers.” They are your neighbors, your family, and your friends. Treat them as such. You may not be able to provide medical care outside your scope of practice, but there is plenty you can do to help care for the patient and others at the scene. Following are some tips for effectively serving as a customer service agent and company ambassador outside of the cockpit:

  • 1. Be nice! Treat everyone with respect, kindness, patience, empathy, and consideration, as if it were your own grandmother you were there to help. Introduce yourself if appropriate, not just to the patient but also to family members, other hospital staff, security guards, or other first responders. Regard everyone as a customer! It will not hurt to smile.

  • 2. Have the correct attitude. Your attitude is the only thing you have 100% control over. Practice having a good one.

  • 3. Be mindful of your body language. It can speak louder than you can sometimes!

  • 4. Remember everyone's safety is a priority including yours, the medical crewmembers’, and the patients’. If the aircraft is not safe to fly, it would be unreasonable to expose them to a higher level of risk than they already are. You must be able to communicate this tactfully to anyone at any time including family members, hospital staff, or other emergency workers on scene, including the very upset highway patrol officer in our previous example.

  • 5. Learn the ambulance part of your aircraft and the associated equipment, including gurney/medical bed operation and other common pieces of equipment and apparatus. When someone says “Please go get the airway bag and portable suction,” you should know what these things are.

  • 6. Take note of what is going on around you and at the scene. Gain some situational awareness. Look for opportunities to help. The following are some ideas:

    • a. Is the spouse, family member, caregiver, or friend present? Ask them if they need anything or have any questions about what is going on.

    • b. If you know the destination hospital, offer to provide the family member with the hospital name, address, and phone number. Ensure them that their loved one will be in good hands, and your medical crew is the best in the business.

    • c. Let the patient and any family members know the approximate flight time to the receiving facility and any anticipated flight conditions that may be concerning to some. Helping manage their expectations can be very beneficial.

    • d. Ask if the patient needs any personal belongings such as keys, wallet, cell phone, slippers, a robe, a jacket, or a walker. Help them get these things and carry them out to the aircraft as needed.

    • e. In our previous example, could you be of service placing orange cones around the disabled helicopter? Could you help direct traffic? Could you grab a push broom from an apparatus on scene and help sweep up broken glass? Make yourself available to others. You may be surprised at the work they find for you.

  • 7. Help take care of the ones who are actually providing medical care for the patients! If time permits while you are waiting, offer to go get coffee or food for anyone who may need it. Order food delivery to the aircraft or fixed-base operator while waiting for your medical crew to return from their patient transfer at the receiving facility. Offer to get coffee or water for a busy security guard or exhausted charge nurse. This may go a long way with a weary medical crew who has not had a chance to eat anything properly during the shift.

  • 8. Do not disqualify the customer with your impressive qualifications. Everyone is superior to you in some way. Recognize this and remain humble.

  • 9. Consider how you and your actions outside of the cockpit are perceived by others. Whether driving a company vehicle, shopping at the grocery store while in uniform, or socializing at an industry event or conference, keep in mind how others perceive you. You are the face of your organization.

  • 10. Be good at your job and continue to improve at every opportunity. These customers rely on us to perform to the best of our ability. A continuous dedication to excellence is a requirement for this job. If there is a way to get the job done legally and safely, find it. Figure out how to solve the complicated problems. Put those amazing piloting skills to work and do your part as part of the bigger air medical transport team.

These are just a few ideas of how you can better serve your customer (ie, friends, neighbors, other emergency workers, hospital staff, passengers, and family) every day. Be empathetic and look for ways to help. If you don't know, ask “How can I help?” The patient and their family may not always remember you, but they will always remember how you made them feel. The little things you do (or fail to do) go a very long way!

The job description for an air ambulance pilot includes much more than just safely piloting an airplane or helicopter. It involves being an outstanding customer service agent and ambassador for the company. Our basic organizational behavior must become customer centered, and we must continually improve our customer service performance.1 Keep this in mind, and you will be better equipped to help care for patients without actually providing patient care.


  1. 1 AC. Brunacini Essentials of Fire Department Customer Service (1st ed.), Fire Protection Publications, Stillwater, OK (1996)


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